Lower facial and perioral scars from burns or defects following treatment of vascular lesions can lead to serious facial deformity with lip ectropion and asymmetry. Conventional reconstructive methods like skin grafts or free flaps do not always give a satisfactory aesthetic outcome. The authors present a technique to expand existing skin for improved colour match, pliability and sensation. They present seven patients who underwent treatment with an expanded submental flap, which was designed to reconstruct lower facial scars or defects. A tissue expander was inserted through an incision at the edge of the previous lesion. The facial artery was at lateral edge of the expander and the inferior edge of the expander was at the level of the hyoid. The expander was placed above the platysma muscle. Eight days after insertion, the tissue expander was inflated and this continued twice a week for two to three months. The final volume of the expander was 2-2.5 times that of the designed volume of the expander. After removing the expander, a rotation flap of expanded skin was raised to repair the lower facial defect. The procedure could also be performed bilaterally. A unilateral expanded flap can still cause asymmetry at the corner of the mouth and may need further surgery. The longest follow-up period was three years. All of the flaps were well matched to the surrounding skin with respect to colour, texture, and thickness, and also allowed increased mouth opening due to better tissue pliability. The donor site scar was mainly hidden under the chin. This paper contributes to the literature on tissue expansion to repair lower facial defects, with an elegant technique.

Repair lower face defect with an expanded flap from submental and submandibular region in children.
Shen W, Cui J, Chen J, Zou J.
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Aina Greig

St Thomas' Hospital, London, UK

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